Diagnostic performance of the Chinese Thyroid Imaging Reporting and Data System combined with BRAF V600E testing for Bethesda category Ⅲ nodules of different sizes

LIU Yan-chen; LU Xiu-bo; WANG Chong; SHAN Yu-bo; LENG Zi-xing

doi:10.19538/j.cjps.issn1005-2208.2025.09.12

Abstract：Objective To evaluate the diagnostic value of the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)combined with BRAF V600E mutation testing in differentiating benign and malignant Bethesda System for Reporting Thyroid Cytopathology(BSRTC)category Ⅲ nodules of different sizes.Methods A retrospective analysis was performed on the clinical data of 161 patients(161 nodules)diagnosed as BSRTC category Ⅲ by fine-needle aspiration(FNA)at The First Affiliated Hospital of Zhengzhou University between March 2020 and November 2023.According to the maximum diameter,patients were divided into a ≤10 mm group(n=125)and a＞10 mm group(n=36).Postoperative histopathology was used as the gold standard.Receiver operating characteristic(ROC)curves were plotted to compare the diagnostic performance of C-TIRADS,BRAF V600E testing,and their combination for BSRTC category Ⅲ nodules of different sizes.Results Postoperative pathology revealed 108 malignant and 53 benign nodules.In the ≤10 mm group,the sensitivity,specificity,and accuracy of C-TIRADS were 72.6％,86.7％,and 76.0％,respectively;those of BRAF V600E testing were 79.0％,100.0％,and 84.0％,respectively;and those of the combined method were 91.6％,86.7％,and 90.4％,respectively.Compared with C-TIRADS or BRAF V600E testing alone,the combined method significantly improved sensitivity(P＜0.001,P=0.002)and accuracy(P＜0.001,P＜0.001),and its diagnostic efficacy was superior to C-TIRADS alone(AUC:0.944 vs.0.796,P=0.003).In the＞10 mm group,the sensitivity,specificity,and accuracy of C-TIRADS were 84.6％,91.3％,and 88.9％,respectively;those of BRAF V600E testing were 61.5％,100.0％,and 86.1％,respectively;and those of the combined method were 84.6％,91.3％,and 88.9％,respectively.The diagnostic performance of the combined method showed no significant difference compared with C-TIRADS or BRAF V600E testing alone(P＞0.05).Conclusion C-TIRADS combined with BRAF V600E mutation testing provides better diagnostic efficacy for BSRTC category Ⅲ nodules with a maximum diameter of ≤10 mm and helps improve diagnostic accuracy in small BSRTC category Ⅲ nodules.